Tuesday, October 19, 2021

Memories of the Victoria Memorial Eye and Ear Hospital

Some wistful memories of the Victoria Memorial Eye and Ear Hospital

By Dr Nihal D Amerasekera

This account is dedicated to Zita and Joe Subasinghe for a lifetimes' work in Ophthalmic Services both in Sri Lanka and the United Kingdom.

The Victoria Memorial Eye and Ear Hospital with its imposing architecture is an iconic landmark in Colombo. It faces the Lipton Circus, the roundabout named to remember Ceylon Tea that became famous all around the globe. This is now called the De Soysa Circus named after the philanthropist and entrepreneur Charles Henry De Soysa who also has the De Soysa Maternity Hospital named after him. The Victoria Memorial hospital established in 1906 was named to honour Queen Victoria and her Diamond Jubilee that was celebrated in 1897. 

This red-brick colonial building was designed by Edward Skinner a British born Architect who emigrated to Ceylon circa 1894. The red bricks used in its construction gives it a grand and distinctive appearance. The history of red bricks dates back to the 12th century in Central and North-Western Europe. Many of the famous 19th-century hospitals in London were made of red bricks like the University College Hospital and the Moorfields Eye Hospital. Skinner designed several recognisable buildings in Colombo including parts of the Galle Face Hotel, Cargills and Co, Victoria Masonic Temple, Wesley College, Lloyds Building in the Fort, and St. Andrew's Scots Kirk in Galle Road Colombo. Although the Gothic Revival in Western architecture survived into the 20th Century, Edward Skinner most appropriately, decided on an Indo-Saracenic model for the hospital. The design and construction of the domes are reminiscent of the architecture of the Mughal period. The doors and windows have neat and stylish polychrome brick arches. Architecturally it can more than hold its own against the best of that period in the world. 

The wife of the British Governor of the time, Lady Ridgway, laid the foundation For the Victoria Eye Hospital in 1903. It was opened for business with great optimism 2 years later. The cost of the building was divided equally between the government and the Anglophile general public. In 1905 it was considered the best in the colonies. It is now part of the National Hospital of Sri Lanka. 

My earliest connection with the eye hospital was in 1952. I was far too young to appreciate its formal beauty. The world was a totally different place then. The veteran politician Dudley Senanayake was our Prime Minister. The doyen of cricket, F.C de Saram, captained the All-Ceylon team. I was then a scraggy kid in the boarding at Wesley College. Cricket occupied much of my mind and a great deal of my free time. I couldn’t read the blackboard in class and complained to the school Matron. She sent me with a chaperone to the Victoria Eye Hospital. I recall a young doctor’s questions about my vision. It amused him no end when I said I couldn’t see the blackboard nor the cricket ball. From then on, I began to wear glasses. Although I could read the blackboard, it never improved my cricket. 

I saw the Victoria Memorial Eye hospital every day when I was a medical student in the 1960’s and this exemplary building is now deeply rooted in my memory.  By then the Ophthalmology Services had moved to the brand-new hospital just around the corner from the old. The New National Eye Hospital of Colombo was established in 1962 to cater to the growing demands of the 20th century. Everything was moved to the new site, lock stock and barrel. In the melee the new relegated the old to near obscurity. The old Victoria Memorial Hospital, although parts of it were allowed to be derelict, continued to provide a service.  There was an ever-increasing demand for space in healthcare. In 1967 the Prime Minister Dudley Senanayake opened the Accident Service in the Victoria Memorial Hospital. 

When I worked at the Central Blood Bank in Colombo in the early 1970’s the Victoria Memorial Hospital housed the Accident Service of the General Hospital Colombo. it was a part of my duties to cover the Blood transfusion work of the Accident Unit at night when the full time Medical Officer was away. I remember there was an ornate wooden staircase with beautiful carvings leading up to my office. The Office was a single room with high ceilings and two large windows in front facing Ward Place. There were lovely views of the red Leyland buses and the slow traffic that chugged around the Lipton Circus. I could see Peking Hotel which was beautifully lit which has now given way to Rajya Osu Sala. The rear wall had beautiful decorative wood panelling and I did  my work in Victorian splendour. 

My sojourn at the Accident Service was an enjoyable one as most of the doctors who worked there were known to me. We were all young and idealistic. I soon got used to the buzz and the rush of adrenaline with the arrival of the ambulances. In those distant days the sirens and the flashing lights were less conspicuous. At times there was a sense of dread, and an expectation of a life-defining situation. I saw for myself the tragic drama that unfolded day after day and the weeping and the wailing that followed. It was a most humbling experience. We were in the habit of chatting away late into the night when there were gaps in the busy workload supported by multiple cups of coffee and tea. I look back on those years with great nostalgia of the friendship and the warmth that prevailed despite the sleepless nights. 

Typical of Victorian buildings the hospital was a rabbit warren of narrow corridors and a multitude of rooms and recesses. At night much of it was dark and unlit. in the gloom they become ominous passageways. There is a strange belief which is universal that most old buildings were haunted. There were stories abound of mysterious happenings at night. Some believed the hospital was haunted by ghostly figures. The doctors who slept in that building have heard strange noises and others spoke of seeing humanoid figures appearing through closed doors. I slept in a dimly lit room in the Blood Bank. In all my years I never saw or heard anything untoward except the occasional cries of pain or screams of despair from the Accident Service which was right below me. 

The Victoria Eye Hospital was built when architects created buildings for its elegance and beauty while making it functional and fit for purpose. On my occasional visits to Sri Lanka, I was appalled by the disdain shown to this landmark building in later years. There were large advertising billboards and hawker stalls covering the grandeur and the magnificence of its redbrick façade. The splendid entrance gates and the elegant porch are not in use anymore. Disuse, disrespect, and decay seemed everywhere and I feared may even destroy this forever. I am reliably informed and delighted to hear that the hospital remains a part of the National Hospital of Sri Lanka and has a Burns Unit, Surgical Theatres and also some Neuro Surgical Services. 

As a medical student in the early 1960’s I had the good fortune to learn my trade in the new eye hospital. The post-World War II era is known as the age of brutalist concrete when beauty gave way to the cheap and cheerful. The 1960’s however was a time of enormous socio-political change which was reflected in the architecture of the time. Even if the designs were not pleasing to the eye they were practical and functional. Although the New Eye Hospital looked a huge block of concrete it was a state-of-the-art hospital with a modern layout and the very latest of facilities. With large wards, better lighting and fine operating facilities this was a far better working environment for the healthcare professionals. The design enabled the seamless interaction between clinicians, patients and students. The spacious waiting rooms and large airy areas dedicated for Out-Patient Clinics made it so much better for the public. I remember with affection the dedication of the eye surgeons and the high quality of the care they provided. 

I am overwhelmed by a heady rush of history when I see the old hospital now. The Victoria Eye and Ear Hospital indeed is a part of our colonial past. Time catches up with all, but the past will always be present in our lives. Although well over a hundred years old, even now when the sunlight catches the paintwork the building looks a masterpiece. The hospital should be listed and preserved for posterity. 

Edward Skinner was a brilliant architect. His wisdom and designs won him the admiration of the City and was popular and much sought after in Ceylon. He had his offices in the Colombo Fort. When he was recently married, he had a cycle accident and suffered with concussion from which he never fully recovered.  Sadly, Edward Skinner took his own life by hanging in his own office in the Colombo Fort on Boxing Day in 1910. The stunning designs he created in prestigious buildings in Colombo will remain as monuments for his superb architectural ability. Part of him will forever remain in the Victoria Memorial Eye and Ear Hospital. He died, far too young, at the age of 41 years when he had so much to offer this wonderful world. 

43 comments:

  1. Nihal, I really enjoyed reading the very nostalgic historical account written by you regarding the Victoria Eye Hospital, When I assumed duties in Galle in 1980, I had a call from home informing me that my mother had been admitted to the Accident Service after a fall. When I rushed back to Colombo and visited her in the old Accident Service at the old Victoria Eye Hospital, I was much relieved to be informed that Rienzie Peiris was "on take". I visited him at his residence in Borella and discussed with him about her future management. When I informed him that her only co-morbidity was mild hypertension, he decided to perform a partial hip replacement, in spite of her being 80 years old, Because of that intervention, she enjoyed excellent quality of life for another 17 years and finally passed away in 1997, at an age of 97 years, As I was in Worthing Hospital at that time on sabbatical leave, I came home for the funeral. I am convinced that my mother had an extension of 17 years of excellent quality of life because of Rienzie's intervention. I had the pleasure of teaching Rienzie's daughter in Colombo, in the mid 1970s. She qualified as an ENT surgeon and worked at the LRH for a short time before an untimely death.
    Rienzie and HMP Perera, Paediatrician were married to two of HVJ Fernando's sisters and lived in adjoining houses at Horton Place
    Recently I was invited for Charles Henry de Soysa's birth anniversary celebrations which was held in the permises of a church ,close to the Eye Hospital GL Peiris was the Chief Guest. On that occasion I met CC de Slva's daughter, Illika Karunaratne.

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  2. Hi Sanath
    Thanks you for commenting and including some of your relevant recollections of personal events. They bring to the surface pieces of history. They remind us of the people who were once in our lives. Some of them were our teachers whom we greatly respected. This indeed is the great benefit of living in SL amongst our own people. Your lives become part of that history.

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  3. Nihal, that was really interesting. I never researched the history of the iconic hospital and didn't even realise that it was Eye and Ear hospital; thought it was seen and not heard like some children! The similarity in architecture to Cargills is now clear with Skinner being responsible for both. His end was rather tragic and disconcerting to read. I also discovered that there is a Royal Eye and Ear hospital in Dublin with similar architecture and built in 1895, a few years before our one. I guess that both have in common the Queen Anne type of architecture but you may know better.

    I do recall the Accident service and some nights spent there to gain experience. The new Psychiatric Unit under that great teacher Prof Channa Wijesinghe was also quite close. Digressing a bit, I shall always be grateful to Channa and his Registrar Patrick Fernando for making Psychiatry interesting and rewarding. They rescued it from the stereotyped "Angoda" days and showed us how relevant the subject was. It is a goood example of how a good teacher can make such a difference. I remember finding History as taught at Royal intensely boring as we were asked to stand up one by one and read a page. Then one day a teacher called Mr Samararatne (Pol Tokka) came as the usual teacher was indisposed and he was a breath of fresh air, having us in rapt attention as he made the history lesson one big and enthralling story.

    Lastly, I must congratulate on your drawing which has captured the unique nature of this magnificent building.

    Sanath, it was so good to hear the way Rienzie dealt with your mother. It would have been all too easy to adopt a negative attitude and condemn her to a life of dependence and misery. I just wondered if she would have been treated the same way if she wasn't connected. Rienzie too was a brilliant Teacher who stressed on the fundamentals and always made sure that the essence was not lost in getting into detail.

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  4. Mahen and Sanath
    Thanks to Mahen for publishing my work. I realise it is unpaid work taking your time and effort. Despite the inevitable ebb and flow the blog meanders on to keep us together.
    Although I have no talents in Architecture or design, beautiful buildings fascinate me. The Chapels at Trinity College Kandy, St Thomas' Mt Lavinia and St Joseph's Darley Rd are so beautiful. The lovely view of the redbrick buildings of Royal College while watching cricket from Reid Avenue, a sight for sore eyes. I recall being mesmerised by the beauty of the Neo-baroque style old Parliament building by the sea facing the Galle Face Green made to house the Legislative Council.
    I agree with Mahen, we were taught history to memorise dates and events a veritable bore from start to finish. I think we were asked to make our choices of Science/Arts/Commerce far too soon. This accounts for the huge gaps in our knowledge of the world history and geography. At senior classes those subjects were taught by specialist teachers who made it interesting.
    I wonder where Channa Wijesinghe is. I know that Patrick Fernando emigrated to Tasmania and is now no more.
    I worked at the Royal ENT Hospital near Kings Cross station as part of my SPR rotation from University College Hospital. Another fascinating Victorian building that housed some of the original Xray machines. The basement is a place with such archaic furniture and equipment where It wouldnt surprise to see Roentgen himself.

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    1. Nihal, Thank you for your article,dealing with memorable buildings, that are forgotten by the present generation. I had the privilege of visiting the Old Victoria eye hospital to meet a friend who was working in the Dept of Leprosy. They had a clinic at the time and my friend was an Apothecary. I too enjoyed the beauty of the Cargill's superstore on my visits to Colombo Fort. By the way Dr Channa Wijesinghe was living in Melbourne with his wife(Malkanthie)after retirement. That was many years ago. As far as the history that was taught in Ceylon was consisted of three subjects, namely Ceylon History, European History and English History. Students who aspired to enter the Universities were allowed to sit for the Entrance exam. In junior classes it was a mixed bag, with more interest in Ceylon history.

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    2. Hi Sumathy
      Many thanks as always for your thoughtful comments and the support for the blog for so many years. Without that support the blog just could not exist. I simply wish we had a much longer time with a greater variety of subjects including history and geography. There is so much to know and so little time to know it all.

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  5. Nihal
    Congratulations for the beautiful painting of the old Victoria Memorial Hospital and an excellent exploraton of this majestic architecture.
    Sri lanka should be proud of this valuable building and should be preserved for our future generations to witness this architecture.
    I must admit that I learnt so much about this old Eye Hospital though I am an Ophthalmologist. Thank you very much. Chira

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  6. Chira
    Thank you so much for the comments of encouragement you give those who contribute to this blog. It makes such a difference.
    Please thank your son for sending me the details of the current status of the Old Hospital and that it is still in use.
    As I have said when we were students we had already moved to the New Eye Hospital and didn't have much to do with the Victoria Hospital. But it remained a building of beauty in the background.
    I recall visiting the new hospital to see Dr Parajasekeram about my vision. He told me in no uncertain terms that medical students dont get preferential treatment. I do respect his view on that and thank him for the excellent care. This minor incident made me give that extra bit of care to healthcare professionals. For all doctors and their families I did waive my private fees.
    My eye appointment as a medical student was with Dr Deva Adithya. A memorable month and a more memorable finale.

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  7. Hi Nihal
    Thanks for an interesting article,well presented as usual. I feel that in real life the beauty of the Victoria memorial is diminished by the congested traffic and crowded surroundings.Your lovely painting shows the whole building without the
    distractions, well done.
    Dr Deva. Adithya was an interesting character and very fond of an "adiya".When I was an intern at the LRH,he was requested to "Please see and advise" us on a three month old baby with extensive burns( both eyes were involved too) .I accompanied him to the patient's bed side.After examining the eyes ,he looked at the babies palms and whiphered to me,No life line.
    At the end of the consultation the kind doctor invited me home for a drink which I very reluctantly refused.
    What was the memorable finale with Dr D.A ?. I remember Tilak telling me that after the Eye appointment he invited Tilak and the rest of the group to Hotel De Roi in Borella for a drink(Adiya) and they had a great time.

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    1. Hi Bora
      Thank you for your comment and the inevitable narratives that raise a welcome smile in these hard times. It is a fact the true beauty of the Victoria Eye hospital has been hidden by the traffic, billboards and hawker stalls in addition to the dust and grime of Colombo since the days we were medical students.
      Next door to the Eye hospital was the Dental Institute. There was a bus stand just opposite the institute for those going to Wellampitiya. There were occasions when the queue for the bus merged with the one to the dental institute with disastrous results as I overheard an elderly lady complain that she wanted to go to Wellampitiya and had her tooth pulled out. She seemed pleased that an extraction long overdue happened inadvertently.
      After we did Dr D.A’s appointment he invited us home for a drink. With the neat whisky the boys were soon legless and had difficulty in getting up from their seats. The dinner was arranged in a restaurant and some of us got into Dr D.A’s car and others into Rohini Abhay’s Mercedes. Dr D.A’s son who was around 12 yrs old insisted in travelling in the Mercedes. During the journey one of us, inebriated chaps, in the Mercedes made a disparaging comment on our host which was duly conveyed to him by his son. Dr D.A was furious and this showed during the dinner when long periods of uncomfortable silence prevailed.
      We await the next episode of Bora’s banter

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    2. Bora
      As for the painting I am pleased it looks good and thank you. I got a photo/artists impression of the building soon after it was completed and functioning and simply made a drawing of it. So none of those distractions exist.

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  8. Bora, Hotel-de Roi, belonged to H N Wickramasinghe's father-in-law

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    1. I remember Hotel Du Roi. Not sure of the correct spelling. HN Wickramasinghe and I did 6 months of internship in Paediatrics in Kurunegala. Such a lovely guy and such wonderful company. I recall with much fondness our many visits to the Rest House for a drink after a long day in the wards. My abiding memory of our time together is the drink we had with our first pay. It tasted so good after the long years of hard work to get where we had arrived. One of my greatest regrets was my inability to keep in touch with HN more closely over the years despite the oceans that separated us. I met him just the once since those halcyon days at a party at RS Jayatilleke's house by the sea. May he find the ultimate bliss of Nirvana

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  9. Lama, Hotel-de-Roi sounds, French. The English translation must sound like King's hotel or Hotel of the king in French.de is of in French. No wonder late HN was a rich guy. For the average Sri Lankan roi sounds Roy.

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  10. Sumathi. I think you are correct. It shouid really be “Du Roi” and not De Roi. Du Roi means of the King or belongs to the King.

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  11. le roi in French means the King and DU roi means of or from the King.
    roi should prounce as rawa and not Roy. oi in French has a "wa" sound. R

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    1. But it is du roi and not de roi- do y9ou agree?

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    2. Sumathy and Mahendra
      It is Hotel Du Roi as I have been there during my boozy years at the Central Blood Bank Colombo.

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  12. du is formed by combining de le for male names in French, de la is used with female sounding words.a roi means a king. au roi should mean from or of the king. Similarly au cinema means to/at the cinema. French grammar is a bit difficult to master for a bigginer. le(male) la(female) du(male) all female words will have de la. Mind you those definite articles are for singular names.

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  13. To Sumathy and all my GP friends and fellow bloggers
    A digression but an important one in our valued blog. There are many of our batch who went into General Practice in the UK and now retired after successful professional lives. Covid seems to have changed General Practice beyond recognition. Face to face consultation with a GP have become increasingly difficult at a time many of us from our batch are at a certain age requiring greater access to healthcare. Even though the Covid restrictions are mostly at an end in general life the GP’s cling on to what existed at the height of Covid. We all recognise General Practice isn’t easy and the doctors have to be all rounders to deal with all that comes through the door. As the access to GP’s have got difficult patients end up clogging up Accident Units up and down the country. I wonder what our bloggers think of the current situation. Making diagnoses on the phone??? Whatever next??

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  14. Nihal, I can't find a NHS Dentist for the last 2 years.I had to go private for a dental extraction. Recently I had fracture of an old filling that needs repairing. I am sure it is going to cost a fair amount.NHS is a sick giant and is unfit to run the service.

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    1. Sumathy
      Thank you. Are you suggesting we are now seeing the bigger picture where the government just cannot manage s free health service for all? Longer waits for healthcare and encouraging those who can afford to pay for a better and quicker service to use their credit cards.

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  15. Dental services were not free at all for evert person in UK.It depends on income.as you are well aware of.It is time that NHS import from EU or from the third World.I am sure they will perform a better job at a cheaper rate?

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  16. You have opened a Pandora's box Nihal! This is a big topic and I cannot do justice to it in a short comment but my response is as follows.
    On telephone consultations: A perfectly sensible way for selected patients. It should not be a blind “all must be screened by a telephone consultation”. Mix and match sensibly.

    On the NHS affordability. I firmly believe that it can be financed with public money but with some caveats. The Public has been led to believe that anything is possible in the NHS and everybody is entitled to everything. The emphasis should not only be on entitlement but on responsibility. Some of the unrealistic expectations are crippling the service and making working as an employee thankless.

    The UK can never provide the manpower required through its own resources and will need to attract health care workers from abroad.
    Private Healthcare is a good thing to run in parallel but there must be clear guidelines and implementation of rules on how NHS workers could work in the Private Sector. There are good examples of private-NHS partnerships but they must be regulated and controlled. Blind adherence to black and white thinking is never good. The labour Left extreme and the Conservative Right extreme are hung up with their ideologies and what we need is a sensible middle path.

    The impression that we cannot afford a state funded NHS is wrong. The people want it and I are willing to pay for it but they also do not want the market and models whereby huge salaries and bonuses are paid to Chief Executives and Directors of Trusts to continue. The Industrial enterprise models being followed with too much emphasis on defensive practises and crippling red tape and protocols is what is ruining the Health Service. The Private Market would like to see nothing better than the collapse of the NHS as the potential profits in a multi-billion pound market is huge. A lot of American providers are smacking their lips in anticipation. I hope that day will never come.

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  17. Speedy, your comments are excellent.NHS has become a political football. It is humanly impossible to create a NHS Utopia. Myopic vision among the Administrators is hemorrhaging tax payers, money. 111 service is a waste of money, in my short experience. There are a lot wasting valuable time of GPS and hospital services. I am sure, Speedy must have experienced all these during his day's, battling with the patients. I have come across so many patients who requested tons of painkillers. When ever I did home visits, I made a point to drop into their bath rooms to discover loads of medicines, untouched."God" save the NHS.

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    1. Thanks, Sumathi. One day, the British people will realise the true value of the NHS and sadly, it might be too late. To grow a tree takes years; to cut a tree only takes hours!

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  18. I wish to see the health system in US,Canada. Australia and New Zealand in much detail. I am sure Srianee, Kumar And Rohini will be willing to contribute to the blog. It's a hot topic at the moment.

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  19. Since my youth I believed in the premise that education and healthcare should be free for all. Education was totally free in the UK but now students pay for University education. I started my journey in the NHS almost 50 years ago with the greatest admiration for those who founded the organisation in 1948. The world has moved on greatly and is a vastly different place now. The cost of managing hospitals has spiralled out of control. There are many more receiving care now than ever before. The care costs are increasing exponentially. Pharmaceuticals, hospital equipment like MRI and CT scanner are expensive costing millions. The scanners need regular replacement. Patient expectations have risen. Many more healthcare professionals are required to cater to the rising demand. More patients demand the best healthcare and faster. The budget for doctors wages are enormous and the hospital managers are paid huge sums of money. I do not think a hospital needs so many managers each one with a retinue of support staff.
    A free NHS for all is an impossible dream. We see the results of the declining services and the inability of the NHS to cope. There is widespread patient dissatisfaction with long waiting lists.
    We must keep to our moral obligations and provide free healthcare to children, elderly, long term sickness and true medical emergencies. I believe the rest must pay 10% of the cost of healthcare.
    All who attend GP surgeries and A&E for non emergencies should be charged a flat fee of £5.00. These services are misused by many.
    The cost of patient litigation is enormous and borne by the NHS. The payouts should only be for proven medical negligence. On many instances the government pays the legal bills to litigants to sue the NHS.
    The budget for the NHS is paid from the National Insurance collections. The National Insurance money is also used for state benefit, state pension and several others. It is the government that decide how much should be given to the NHS. I think there should be a separate tax for healthcare which should go into a separate pot and the public made aware how it is utilised.
    Our religion, moral code and ethics drive our minds to a free NHS for all. We have to face reality and do what is possible making the service available free for as many people as the NHS can afford.
    Diagnosing the ‘illness’ of the NHS is an enormous task. This cannot be done on the back of an envelope as I am trying to do. Once the ‘Illness’ is diagnosed the ‘treatment’ is another enormous task. No government has the will power nor the courage to do what is needed to put the NHS in a better footing. I want the NHS to survive but also to provide a good service.
    A free NHS for all, from cradle to grave, is simply a pipe dream.

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    1. I shall respond in detail. Just to point out that the phrase "Free NHS" could be misleading. It is not free and has never been as it was and is still funded by tax payers money.

      A flourishing Private sector is important for many reasons. One is the fact that people with higher incomes are prepared to pay for some helth care costs out of their own pockets and should be allowed to do so. The difficulty is that it is well nigh impossible to have a set of doctors (and some other health care workers) working exclusively in that sector. This is the ideal as then there is no conflict of interest. But manpower will never be able to meet that. That is why in my view, strict controls and procedures are necessary to make sure that those who work in both sectors discharge their duties honourably. I think it is possible but difficult because Human greed and lust for money will stand in the way: but it is possible.

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  20. The NHS is free at the point of service. As I had pointed out the National Insurance we pay is to cover a multitude of services. That doesn't cover the cost of the NHS and that exactly is the problem. This belief that is rampant amongst the general public that we pay for the NHS is just a half truth. The fact is it is never enough to cover our insatiable need for healthcare.
    The NHS should have no right to dictate to the Private Sector which will be guided by the financial constraints of supply and demand. An organisation that cannot manage itself cannot influence the private sector that is thriving.

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  21. You are correct about the use of NI funds. The NHS is NOI funded through NI. You pay National Insurance contributions to qualify for certain benefits and the State Pension. National Insurance is a tax on earnings and self-employed profits. National Insurance contributions are paid into a fund, from which some state benefits are paid. This includes the state pension, statutory sick pay or maternity leave, or entitlement to additional unemployment benefits.

    It certainly doesn't meet NHS costs (although as you say, some have this misconception). Nevertheless it is still true that the cost of the NHS is met by the state (essentuially taxation). There are some costs which are partially paid by the userm such as medication for non-exempt groups.
    Let us leave aside NI. The point is that the NHS is funded via taxation. Which to me is the way it should be. I supported what the Old Lib Dems suggested, i.e., an ear marked and ring fenced healthcare tax. The cost of healthcare cannot be easily met with any policy and the fact remains that as a just society, we have to subside the unfortunate poor who cannot afford to pay.

    As for PP, there has to be some way of stopping misuse by Consultants who work in both sectors. There are honourable people like you who never misused it but the Medical profession is powerful and is capable of allowing unfair practice to continue. There has to be safeguards in my view.

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  22. Taxation without representation is redicoulous.

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  23. Mahendra
    We have diametrically opposite views of how the NHS should move forward to make it better for everyone and we can agree to disagree . I know you well enough to respect your views which have been made after due care and thought and without concern for any personal gain. No doubt it comes from your deeply held philosophy and principles.
    I cannot agree with you more about the misuse of Private Practice in the NHS by some unscrupulous Consultants. There should be more rigorous policing of such malpractice. Private medicine practiced within the confines of the NHS in their own hospitals too need careful supervision to maintain waiting lists in a way that is equitable to the non-paying patients. This is not always easy to supervise but the situation has indeed improved.
    The Private practice done by NHS Consultants in Private Hospitals cause problems too with those doctors not fulfilling their NHS contracts and commitments. I believe the ability of NHS Consultants to work in private hospitals is a quirk that has existed since the inception of the NHS. Architects and solicitors who work for companies are not allowed to work for anyone else other than for their own employers because of conflict of interest and conflict of time.

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    1. Nihal, I don't think we differ to the extent of being "diametrically opposite"! (Possibly on Funding but not on PP). I am not against PP at all. Good PP gives users who are willing to pay more flexibility and it also reduces the demand on the NHS. I am not a Left extremist who considers that the possession of money should not confer any advantage. This is not realistic. Money does give advantages, be it housing, travel, material possessions etc. and it is a perfectly legitimate desire to use your money for health purposes too.

      I do believe that if we leave individuals to be ethical because they have a conscience, that is not enough and there need to be controls, the nature of it needs to be agreed with professional organisations such as the BMA and the Govt.

      We probably differ on how the NHS should be funded and although you have not stated your view on how it should happen, I get the impression that you favour a more direct individualised approach based on individual usage perhaps through a State Health Insurance scheme (like Private schemes but State run). Is this what you favour?

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    2. As I have said before:
      We must keep to our moral obligations and provide free healthcare to children, elderly, long term sickness and true medical emergencies. I believe the rest must pay 10% of the cost of healthcare.
      All who attend GP surgeries and A&E for non emergencies should be charged a flat fee of £5.00. These services are misused by many and will dissuade those who don’t really need care.
      The public has the option of paying for health insurance for private care this can also pay for the 10% for NHS care.
      The cost of patient litigation is enormous and borne by the NHS. The payouts should only be for proven medical negligence. On many instances the government pays the legal bills to litigants to sue the NHS.

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    3. Understandably the NHS has a cult status. It is a like a religion and the free status seems sacrosanct. Hence it has acquired a protective halo for its free at the point of service culture. Despite numerous reorganisations the NHS cannot keep up with the demand. Covid has shown its short comings. This veneration is an obstacle to reform. Despite knowing what needs to be done no government will take on the challenge to introduce a payment culture in the NHS. I sincerely hope it will not grind to a halt before something is done to resurrect its fortunes as we all depend on it more on more. There are many young GP’s and Consultants who think the NHS is on its knees now and cannot survive in its current form. We all need the NHS more than ever and sincerely hope we will have it when we need it.

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  24. My very first Private Patient
    I do not apologise for indulging in private practice but it was not an easy transition. Having brought up in Sri Lanka we all became aware of the huge disparity between the rich and the poor. Our views of life and death were hugely coloured by our deeply rooted culture and religion.
    When I started as a Consultant Radiologist I had never done any private practice before. A chest physician sent me a patient for an ultrasound examination. He had liver metastases and a pleural effusion and was terminally ill. I just couldn’t get myself to charge a dying man. I took my findings to the Chest physician who was working in the next room. When I said I will ask the hospital not to charge for the Ultrasound examination he got me to sit down. He was a cultured senior Consultant who has seen it all and gave me a lecture about the practice of private medicine. The patient had wanted to be seen in a private hospital. He valued the quiet and peaceful surroundings of the Private Hospital and to have everything done on the same day. I did get paid but this incident has stuck in my mind ever since. This story is told not to get my halo but to show how deeply our background and culture affects are thinking and actions.

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  25. ND, you are absolutely correct in exposing corrupt practices by the NHS Consultants. Dental Surgeons are minting money at the moment, purely because there are't enough to take NHS patients. Government is showing a blind eye to it. Taxation without representation that I meant to express my opinion how its wasted by going out to fight wars and create conflicts in other countries. First, put the 🏡 in order and think about the rest.

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  26. Dear Friends, I will relate to you how privileges of Private Practice were given to the University academic staff. On the 1st of January 1975, Prof Rajasuriya, passed away at the age of 58 years. The logical successor should have been David Chanmugam, who was a Reader. However, Dr. Dharmadasa was appointed from the MoH, on secondment for two years. Around the same time, when Prof Ranasinghe retired, Dr. D E Goonetilleke was appointed on secondment for two years. Prof Visvanathan was already a Professor in the same department but was overlooked. I quote this as two excellent examples of communal discrimination. The Minister of Higher Education was Nissanka Wijeratne, in JRJ's cabinet. During their latter part of secondment, privileges of PP were given to the specialists in the MoH. These two threatened to revert back to the MoH, at the end of two years, if the rights of PP were not given to them. If they reverted back to the MoH, Chanmugam and Visvanathan would have occupied the two Chairs. To prevent that happening, PP was permitted for the University academic staff in 1979 and I was one of the beneficiaries; I did a little bit of PP in Colombo in 1979, before I went to Galle in 1980.
    The first case of medical malpractise that I remember was when AEB Kiriella, who was the MP for Kiriella in our first parliament, sued the Central Hospital in Horton Place in the early 1950s, for the death of his younger son Punyasiri, but lost the case. They were our front house neighbours, down 42nd Lane, Wellawatte.
    As you all may be well aware, I played the central role in the Priyani Soysa vs Rienzie Arsekularatne malpractice case in the early 1990s. I made the diagnosis of Brain Stem Glioma. The patient was being treated by Priyani Soysa for rheumatic chorea for over a month at the Nawaloka Hospital. As it was a landmark case, every law student in Sri Lanka (Faculty of Law or the Law College), are well aware of my name.

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  27. Lama, it was pretty difficult to win a case against the Health Service, in those bad old. days. Even the Judges were scared to deliver a verdict of guilt. They too had to depend on the Health Service in SriLanka. One had to be extremely rich to go abroad to get treatment. Well done, Lama, you did better than Priyani, that time, Prof. They felt shy to learn from their Juniors.

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  28. Nihal,
    I apologize for my belated comment. I was obviously distracted by everything that is going on around me; gorgeous fall colors in the trees, and traveling distances to get together with friends before we all have to hunker down for the winter. I enjoyed reading your account of the Victoria Memorial Eye and Ear Hospital, as well as your lovely painting. As Bora said in his comment, your painting thankfully eliminates the clutter, junk, billboards and the walls that now surround and obstruct the view of this unique edifice. I also learned quite a bit of history from reading your excellent narrative. I had no idea that the Cargills building and the "Eye Hospital' were both designed by the same architect. Like you, I am also fascinated by old buildings and their designs. That major intersection in Colombo is still referred to as the "Eye Hospital Junction!"

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